Pelvic organ prolapse is a common problem among middle-aged and older women and risk factors for the development of pelvic organ prolapse are not well defined. While childbirth has been identified as a risk factor for pelvic organ prolapse, there has been limited research on the relationship between specific parturition events and the occurrence of pelvic organ prolapse in later life. Currently, we are conducting the Reproductive Risk factors for urinary Incontinence Study at Kaiser (RRISK), a 4-year funded study to determine the association between specific childbirth events, hysterectomy, hormone use and subsequent urinary incontinence. This retrospective cohort study will enroll 2100 community-dwelling, ethnically diverse women ages 40 to 69 on which there are continuous medical records since the age of 18. All participants had extensive assessment of urinary incontinence and potential risk factors using self-report, in-person interview, and chart abstraction of labor and delivery and surgical records. We propose randomiy selecting a 1100 participant subsample of the RRISK cohort to objectively assess pelvic organ prolapse using the Pelvic Organ Prolapse Quantitation staging system. Our specific aims over the next 4 years are to detennine the prevalence of prolapse by vaginal segment and severity (Stage I- IV), and age group. The ethmc diversity of study subjects will allow comparison of prevalence estimates between major ethnic groups; to determine the association between specific aspects of parturition and development of prolapse in later life; to ascertain the association between hysterectomy (type and indication) and subsequent prolapse; To identify other potential risk factors (heavy lifting, obesity, medical illness, etc.) for prolapse, especially those that are preventable or modifiable; and to describe the associations of pelvic organ prolapse with urinary and fecal incontinence and to compare risk factors for each of these conditions. Our proposed study of reproductive risk factors for prolapse in a well- characterized representative cohort of community-dwelling women will provide an adequate sample size, excellent outcome measures, and extensive reliable data on a range of risk factors for pelvic organ prolapse, including chart abstracted information on important aspects of reproductive history. Identification of risk factors for prolapse will help guide the development of preventive intervention trials to test the efficacy of modifying risk factors for pelvic organ prolapse.